[Effects of coronary insufficiency on the early and late results in patients surgically treated for aneurysm of the sub-renal abdominal aorta].
Between 1973 and 1988, 200 patients underwent repair of unruptured aortic aneurysm located distal to the renal arteries. There were 181 men (90%) and the mean age was 68.8 years. The most serious associated disease was arteriosclerotic heart disease which was present in 102 patients (51%): 48 patients had angina pectoris; 59 patients had previous myocardial infarct; 8 patients had ischemic myocardiopathy. Associated cerebrovascular disease was found in 29 patients (15%). Of these 200 patients, 36% had no symptoms relating to the aneurysm. The aneurysm was associated with iliac aneurysm (19%), iliac occlusion (14%), distant femoral occlusion (14%). In patients with history of coronary arteries disease (102), 39 (18%) had a coronary angiography prior the elective resection, 18 (9%) coronary artery bypass surgery underwent elective myocardial revascularisation prior to elective resection of their aneurysm. The treatment was by graft replacement and exclusively by graft inclusion.


RESULTS
Death occurred within 30 days of treatment in 5 patients (2.5%). The first cause of early death was myocardial infarct (3). Early peripheral vascular complication occurred within 30 days in these 200 patients and were thromboembolism in 12 patients and colic ischemia in 8 patients. Of the 83 patients (1975-1983) who survived operation, follow up information regarding survival was obtained in 79 patients. The overall 5 and 8 years survival rates in percentage in the series were 69% and 50%. The survival rate was greatest in patients free of associated disease and worse in patients with myocardial infarctus. Subsequently 24 vascular operations were performed in these patients: 7 iliac aneurysms, 16 occlusive lesions and 2 false aneurysms.


CONCLUSIONS
Young (15) and associates reported an operative mortality rate of 6.3% for elective aneurysm resection but found that 20% of the patients with pre-operative evidence of coronary artery disease had post-operative myocardial infarct of which 58% were fatal. Hertzer and colleagues (6), using routine coronary angiography prior to elective aortic reconstruction, have documented a 59% incidence of significant anatomic coronary artery disease. This incidence increased to 95% in patients with abdominal aortic aneurysm and suspected coronary artery disease. Only one patient of the 68 patients with an abdominal aortic aneurysm had normal coronary arteries in their series. Thus, considering the omnious implications of coronary artery disease in patients with abdominal aortic aneurysms, routine preoperative coronary angiography has been recommended. For Brown and coll. (1), it would appear that the risk of prophylactic coronary artery revascularisation may be greater than that for elective abdominal aortic aneurysm resection alone in the older age group. For the authors, only patients which instable angina pectoris or angina pectoris with a myocardial infarct had a coronary angiography. The coronary artery bypass is recommended for left maintrunk obstruction or diffuse multivessel coronary artery disease.
Pelissier
F T
FT
Hôpital Cardiovasculaire de Lyon.
Lehot
J J
JJ
George
M
M
Villard
J
J
D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D003327:Coronary Disease / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality*; D015996:Survival Rate
Incidence de l'insuffisance coronaire sur les résultats précoces et tardifs chez des patients opérés d'un anévrysme de l'aorte abdominale sous-rénale.